17 Chronic Renal Failure Nursing Care Plans

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Chronic renal failure (CRF) or chronic kidney disease (CKD) is the end result of a gradual, progressive loss of kidney function. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.

The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.

Nursing Care Plans

The nursing care planning goal for with chronic renal failure is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Below are 17 nursing care plans (NCP) and nursing diagnosis for patients with chronic renal failure or chronic kidney disease:

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  1. Risk for Decreased Cardiac Output
  2. Risk for Ineffective Protection
  3. Disturbed Thought Process
  4. Risk for Impaired Skin Integrity
  5. Risk for Impaired Oral Mucous Membrane
  6. Deficient Knowledge
  7. Excess Fluid Volume
  8. Acute Pain
  9. Impaired Renal Tissue Perfusion
  10. Impaired Urinary Elimination
  11. Imbalanced Nutrition: Less than Body Requirements
  12. NEW Activity Intolerance
  13. NEW Disturbed Body Image
  14. NEW Anticipatory Grieving
  15. NEW Risk for Infection
  16. NEW Risk for Injury
  17. Other Possible Nursing Care Plans
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Risk for Impaired Skin Integrity

Nursing Diagnosis

Risk factors may include

  • Altered metabolic state, circulation (anemia with tissue ischemia), and sensation (peripheral neuropathy)
  • Alterations in skin turgor (edema/dehydration)
  • Reduced activity/immobility
  • Accumulation of toxins in the skin

Possibly evidenced by

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  • Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

  • Maintain intact skin.
  • Demonstrate behaviors/techniques to prevent skin breakdown/injury.
Nursing InterventionsRationale
Inspect skin for changes in color, turgor, vascularity. Note redness, excoriation. Observe for ecchymosis, purpura.Indicates areas of poor circulation or breakdown that may lead to decubitus formation and infection.
Monitor fluid intake and hydration of skin and mucous membranes.Detects presence of dehydration or overhydration that affect circulation and tissue integrity at the cellular level.
Inspect dependent areas for edema. Elevate legs as indicated.Edematous tissues are more prone to breakdown. Elevation promotes venous return, limiting venous stasis and edema formation.
Change position frequently; move patient carefully; pad bony prominences with sheepskin, elbow or heel protectors.Decreases pressure on edematous, poorly perfused tissues to reduce ischemia.
Provide soothing skin care. Restrict use of soaps. Apply ointments or creams (lanolin, Aquaphor).Baking soda, cornstarch baths decrease itching and are less drying than soaps. Lotions and ointments may be desired to relieve dry, cracked skin.
Keep linens dry, wrinkle-free.Reduces dermal irritation and risk of skin breakdown.
Investigate reports of itching.Although dialysis has largely eliminated skin problems associated with uremic frost, itching can occur because the skin is an excretory route for waste products such as phosphate crystals (associated with hyperparathyroidism in ESRD).
Recommend patient use cool, moist compresses to apply pressure (rather than scratch) pruritic areas. Keep fingernails short; encourage use of gloves during sleep if needed.Alleviates discomfort and reduces risk of dermal injury.
Suggest wearing loose-fitting cotton garments.Prevents direct dermal irritation and promotes evaporation of moisture on the skin.
Provide foam or flotation mattress.Reduces prolonged pressure on tissues, which can limit cellular perfusion, potentiating ischemia and necrosis.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other care plans and nursing diagnoses related to reproductive and urinary system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
  • Thank you Matt :) This helped me understand how to do a care plan. I was asked to do one without them showing us a sample first so I was completely lost. Thank you!

  • Hi Matt,
    I’m an RN BSN WCC x 25 years. What you’re doing is great. Keep up the good work. Only suggestion is to broaden examples of applicable POC’s in the community. Community nursing is becoming highly skilled. Especially with Covid. In many cases of CKD, in the community, the CG becomes a huge part of the POC. Teach and Assess must be added to POC.
    Keep going! Its not enough for our nursing students to pass the boards. They need to understand critical thinking, and be creative/problem solve now more than ever.
    Best,
    Sue

    • Hi Sue,

      We’ll do our best to include your suggestion on our nursing care plans (which we are currently updating). And I agree: thinking critically is a must skill. Thank you so much for your kind words!

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